Clinical Examinations Flashcards
Aortic Regurgitation: What is the murmur heard? Where do you auscultate? Common causes? Other clinical signs/manoeuvres?
Early decrescendo diastolic murmur
Left lower sternal border- 3rd/4th intercostal spaces (Patient sitting upright, in full expiration)
Aortic root dilation (Murmur will be louder on right sternal border), endocarditis, marfans syndrome, aortic dissection
Wide pulse pressure, Quincke’s pulse (Repeated flushing and blanching of the capillaries in the nail beds and lips), Corrigan’s pulse (Visible bounding, pulsatile carotid pulse), Water hammer pulse
Cardiac manoeuvre: Isometric handgrip- Increases afterload and blood flow through aortic valve thus increasing sound of murmur
Can also cause austin-flint murmur- regurgitant blood flow across aortic valve causing functional mitral stenosis
Apex beat often displaced inferiorly and laterally due to compensatory left ventricular dilatation
Mitral stenosis murmur
Loud S1 followed by quiet opening snap in diastole and quiet mid diastolic murmur
Increased ventricular filling murmur
S3 heart sound. S1,S2,S3 ends up sounding like saying the word kentucky (One of the two/three gallop rhythms, the other gallop rhythm is S1,S2,S4 or S1,S2,S3,S4)
Often due to a cardiac failure induced dilated ventricle
Stiffened ventricle murmur
S4 heart sound (vibration of left ventricle due to blood flow) S1,S2,S4 sounds like saying the word Tennessee
(One of the two/three gallop rhythms, the other gallop rhythm is S1,S2,S3 or S1,S2,S3,S4)
Where do you auscultate each heart valve?
Aortic valve: second intercostal space at the right sternal border.
Pulmonary valve: second intercostal space at the left sternal border.
Tricuspid valve: fourth intercostal space at the left sternal border.
Mitral valve: fifth intercostal space at the left midclavicular line.
(Murmurs radiate so you have to auscultate in different positions to above)
What does the handgrip manoeuvre do to murmurs?
Increases afterload- accentuates regurg murmurs
What does the squatting manoeuvre do to murmurs?
Increases preload- accentuates stenosis murmurs
What does standing aprubtly or valsava do to murmurs?
Decreases preload- reduces intensity of most murmurs
What does amyl nitrate do to murmurs?
Amyl nitrate: Decreases afterload. Amyl nitrate increases the intensity of aortic stenosis, hypertrophic obstructive cardiomyopathy, and mitral valve prolapse. It decreases the severity of aortic regurgitation, mitral regurgitation, and ventricular septal defects.
What does a tapping apex beat suggest?
Mitral stenosis (Loud S1)
Examination of the neck reveals cannon waves. What is the likely diagnosis?
Complete heart block
Vesicular vs Bronchial breath sounds?
Vesicular sounds (normal sounds): Inspiration vs expiration duration of 2:1, Inspiration is louder than expiration, and no discernible gap.
Bronchial breath sounds (normally heard over large air passages -trachea) may be found in other parts of the lung in lobar pneumonia or consolidation. Inspiratory and expiratory phase is the same and of equal loudness with a gap between
Wheezing heard during which phase?
Crackles/Creps heard during which phase?
Stridor heard during which phase?
Mainly expiratory. Typically caused by airway narrowing. Monophonic wheeze typically bronchial obstruction by tumor, bronchostenosis by inflammation, mucus accumulation, or a foreign body. Polyphonic wheeze typically asthma.
Mainly inspiratory when collapsed alveoli are forced open. Fine creps due to pul oedema or interstitial fibrosis and course creps due to bronchiectasis or resolving pnuemonia
Stridor is during inspiration. Louder in neck region than chest. Typically caused by airway obstruction. (high pitched whistling/gasping sounds). Can also be seen in children with croup or epiglotitis
